responsible for the design, development and operational leadership of the Clinical Business Monitoring Team
Partner with Clinical Leadership to enhance and implement use of monitoring tools, specific defect and exception reports, implement process improvements, and develop training plans for clinical and non-clinical staff
Develops and employs process monitoring tools to identify root cause of potential process deficiencies, and provides timely reporting on productivity, audit results and process improvement opportunities
Responsible for operational knowledge and subject matter expert for regulatory specifications for the business. Lead the business/operational translation specifications to the IT team for universe creation
Participate in Universe governance that would impact changes to the specification and ultimately impact compliance
Manages and develops direct reports who include supervisory and/or exempt professional personnel including but not limited to hiring, mid-year and annual reviews
Ensures department activities are compliant with the regulations and standards that govern the industry
Develops and implements departmental workflows and policies & procedures
Collaborates with other departments cross functionally regarding case management and/or Clinical Services initiatives
Partners with Management team to develop audit plans that identifies and prioritizes areas of significant risk
Reviews and audits the effectiveness of corrective action plans that address report findings and provides comprehensive follow-up to senior management
Develops, implements and manages process improvement initiatives
Proactively monitors appropriate metrics to improve both quality and drive efficiency
Partners with key stakeholders across clinical and non-clinical departments during external and internal audits to provide appropriate documentation and communication

Requirements

A related New York certification or licensure is required for this role
A Bachelor's Degree in Public Health, Nursing, Healthcare Administration, Business Management or related field: Required or equivalent work experience
5+ years in nursing, a clinical setting, managed care, or business reporting/analytics
5+ years of experience in practical work in a business environment with data collection, creation and analytics
2+ years experience in leading/supervising others
2+ years of experience in An acute clinical care setting and/or managed care related experience
2+ years of experience in Case management
2+ years of experience in reading, analyzing, interpreting and/or applying State and Federal laws, rules and regulations
A license in one of the following is required: Project Management Professional (PMP), Certified Business Analysis Professional (CBAP), Licensed Registered Nurse (RN), Licensed Certified Social Worker (LCSW), Licensed Marital and Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC), Certified Case Manager (CCM)

Benefits

competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

process monitoring toolsdata collectiondata analyticsprocess improvementaudit plansroot cause analysisworkflow developmentregulatory compliancecase managementreporting

Soft Skills

leadershipcollaborationcommunicationorganizational skillsproblem-solvingtraining developmentsupervisory skillscross-functional teamworkrisk assessmentperformance management

Certifications

Project Management Professional (PMP)Certified Business Analysis Professional (CBAP)Licensed Registered Nurse (RN)Licensed Certified Social Worker (LCSW)Licensed Marital and Family Therapist (LMFT)Licensed Mental Health Counselor (LMHC)Certified Case Manager (CCM)